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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to the home health aide for medically 2
fragile children program; amending s. 400.54, F.S.; 3
providing requirements for the annual assessment of 4
home health aide for medically fragile children 5
program; amending s. 400.4765, F.S.; revising program 6
training requirements; revising the utilization cap of 7
a Medicaid fee schedule; requiring a home health aide 8
for medically fragile children who works more than 40 9
hours per week to provide specified justification; 10
providing requirements for the Agency for Health Care 11
Administration to seek federal approval and a federal 12
waiver for specified purposes; amending s. 400.462, 13
F.S.; conforming provisions to chang es made by the 14
act; amending s. 409.903, F.S.; requiring the agency 15
to seek federal approval and implement federal waivers 16
and state plan amendments for specified purposes; 17
providing construction; providing an effective date. 18
19
Be It Enacted by the Legi slature of the State of Florida: 20
21
Section 1. Section 400.54, Florida Statutes, is amended to 22
read: 23
400.54 Annual assessment of the home health aide for 24
medically fragile children program. —The agency shall conduct an 25
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
annual assessment of the home heal th aide for medically fragile 26
children program. The assessment must report caregiver 27
satisfaction with the program, identify additional support that 28
may be needed by the home health aide for medically fragile 29
children. A managed care plan shall provide to the agency the 30
necessary data to, and assess the rate and extent of 31
hospitalization of children in home health services who are 32
attended by a home health aide for medically fragile children 33
compared to those in home health services provided by a 34
registered nurse or a licensed practical nurse without a home 35
health aide for medically fragile children. The agency must 36
include in the report data on any sentinel event occurring under 37
the care of a home health aide for medically fragile children. 38
By January 1 of each year, beginning January 1, 2025, the agency 39
shall report its findings to the Governor, the President of the 40
Senate, and the Speaker of the House of Representatives. 41
Section 2. Paragraph (a) of subsection (3) and subsection 42
(9) of section 400.4765, Florida Statutes, are amended, and 43
subsection (10) is added to that section, to read: 44
400.4765 Home health aide for medically fragile children 45
program.— 46
(3) TRAINING.— 47
(a) Before proving services to an eligible relative, a 48
home health aide for medic ally fragile children must complete an 49
approved training program. The employing home health agency must 50
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
provide validation of competency by a registered nurse, and 51
maintain documentation of training completion and competency 52
validation. The employing home health agency must provide 53
additional training and competency validation as the medically 54
fragile child's care needs change and consistent with any 55
changes to the plan of care. 56
(b)(a) The agency, in consultation with the Board of 57
Nursing, shall approve h ome health aide for medically fragile 58
children training programs developed by home health agencies in 59
accordance with 42 C.F.R. ss. 483.151 -483.154 and 484.80 to 60
train family caregivers as home health aides for medically 61
fragile children to increase the he alth care provider workforce 62
and to authorize persons to provide trained nursing services as 63
delegated by a registered nurse to eligible relatives. The 64
program shall include must consist of at least 85 hours of 65
training, including, but not be limited to, all of the 66
following: 67
1. A minimum of 20 40 hours of theoretical instruction in 68
nursing, including, but not limited to, instruction on all of 69
the following: 70
a. Person-centered care. 71
b. Communication and interpersonal skills. 72
c. Infection control. 73
d. Safety and emergency procedures. 74
e. Assistance with activities of daily living. 75
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f. Mental health and social service needs. 76
g. Care of cognitively impaired individuals. 77
h. Basic restorative care and rehabilitation. 78
i. Patient rights and confidentiality of personal 79
information and medical records. 80
j. Relevant legal and ethical issues. 81
82
Such instruction must be offered in various formats, and any 83
interactive instruction must be provided during various times of 84
the day. 85
2. Up to A minimum of 20 hours of skills training on basic 86
nursing skills tailored to the child's care needs as specified 87
in the ordering provider's plan of care and individualized care 88
needs, which may include training on the following topics, as 89
applicable 90
, including, but not limited to: 91
a. Hygiene, grooming, and toileting. 92
b. Skin care and pressure sore prevention. 93
c. Nutrition and hydration. 94
d. Measuring vital signs, height, and weight. 95
e. Safe lifting, positioning, and moving of patients. 96
f. Wound care. 97
g. Portable Oxygen use and safety and other respiratory 98
procedures. 99
h. Tracheostomy care. 100
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i. Enteral care and therapy. 101
j. Peripheral Intravenous assistive activities and 102
alternative feeding methods. 103
k. Urinary catheterization and care and ostomy care. 104
3. Up to At least 16 hours of clinical training related to 105
the specific needs of the eligible relative under direct 106
supervision of a licensed registered nurse. 107
4. Training concerning HIV infections and AIDS and is 108
required to obtain and maintain a current certificate in 109
cardiopulmonary resuscitation . 110
5. Obtain and maintain a current certificate in 111
cardiopulmonary resuscitation. 112
(9) FEE SCHEDULE.—The agency shall modify any state 113
Medicaid plans and implement any federal waivers necessary to 114
implement this section and shall establish a Medicaid fee 115
schedule for home health agencies employing a home health aide 116
for medically fragile children at minimum rate of $25 per hour 117
with a utilization cap of no more than 12 8 hours per day, per 118
medically fragile child. If a home health aide for medically 119
fragile children works more than 40 hours per week, 120
justification must be provided as to why there is no other 121
qualified provider available, and the request must be approved 122
by the home health agency and the m anaged care plan. 123
(10) FEDERAL APPROVAL. —Within 30 days after the effective 124
date of this act, the agency shall seek federal approval, 125
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including seeking the appropriate federal waiver, to: 126
(a) Allow Medicaid private duty nursing specialty 127
providers and home health services providers to participate in 128
and receive reimbursement for services rendered under this 129
program. 130
(b) Provide that the income earned under this program by a 131
home health aide for medically fragile children is disregarded 132
in Medicaid eligibility considerations. 133
Section 3. Subsection (18) of section 400.462, Florida 134
Statutes, is amended to read: 135
400.462 Definitions. —As used in this part, the term: 136
(18) "Home health aide for medically fragile children" 137
means a family caregiver who meets the qualifications specified 138
in this part and who performs tasks delegated to him or her 139
under chapter 464 while caring for an eligible relative, and 140
provides care relating to activities of daily living, including 141
those associated with personal care; maintaining mobility; 142
nutrition and hydration; toileting and elimination; assistive 143
devices; safety and cleanliness; data gathering; reporting 144
abnormal signs and symptoms ; postmortem care; patient 145
socialization and reality orientation; end -of-life care; 146
cardiopulmonary resuscitation and emergency care; residents' or 147
patients' rights; documentation of services performed; infection 148
control; safety and emergency procedures; h ygiene, grooming, 149
skin care, and pressure sore prevention; wound care; portable 150
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oxygen use and safety and other respiratory procedures; 151
tracheostomy care; enteral care and therapy; peripheral 152
intravenous assistive activities and alternative feeding 153
methods; and any other tasks delegated to the family caregiver 154
under chapter 464. 155
Section 4. Paragraph (c) of subsection (1) of section 156
409.903, Florida Statutes, is amended to read: 157
409.903 Mandatory payments for eligible persons. —The 158
agency shall make payments for medical assistance and related 159
services on behalf of the following persons who the department, 160
or the Social Security Administration by contract with the 161
Department of Children and Families, determines to be eligible, 162
subject to the income, as sets, and categorical eligibility tests 163
set forth in federal and state law. Payment on behalf of these 164
Medicaid eligible persons is subject to the availability of 165
moneys and any limitations established by the General 166
Appropriations Act or chapter 216. 167
(1) Low-income families with children are eligible for 168
Medicaid provided they meet the following requirements: 169
(c) The family's countable income and resources do not 170
exceed the applicable Aid to Families with Dependent Children 171
(AFDC) income and resource s tandards under the AFDC state plan 172
in effect in July 1996, except as amended in the Medicaid state 173
plan to conform as closely as possible to the requirements of 174
the welfare transition program, to the extent permitted by 175
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federal law. The agency shall seek f ederal approval, including 176
seeking the appropriate federal waiver or state plan amendment, 177
to exclude from the family's countable income any income earned 178
through employment as a home health aide for medically fragile 179
children under s. 400.4765. 180
Section 5. Within 60 days after this act becomes law, the 181
Agency for Health Care Administration shall make all necessary 182
requests and submissions to obtain federal approval to implement 183
this act amending s. 409.903, Florida Statutes, and initiate any 184
necessary rulemaking to implement the provisions of this act 185
amending s. 400.4765, Florida Statutes. 186
Section 6. This act shall take effect upon becoming a law. 187